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Published on: November 17, 2010
Acute Corticosteroid Responsive Meningoencephalitis with Cerebral Vasculitis after COVID-19 Infection in a
Grâce François1, Pierre Cleuziou2, Quentin Vannod-Michel3
1Clinical Neurophysiology Department, Lille University Hospital, Lille, France.
Insights
A 13-year-old girl experienced acute meningoencephalitis and cerebral vasculitis following COVID-19 infection. Steroid treatment led to recovery, highlighting the importance of prompt diagnosis and intervention for neurological complications of COVID-19.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Neurologic manifestations are increasingly recognized in children post-SARS-CoV-2 infection.
- Encephalopathies, particularly during multisystem inflammatory syndrome, are common CNS disorders in pediatric COVID-19.
- This case highlights a rare presentation of acute meningoencephalitis with cerebral vasculitis in a pediatric patient.
Observation:
- A 13-year-old girl presented with acute neurological symptoms including impaired consciousness, headache, hyperthermia, and aphasia after COVID-19.
- Cerebral MRI revealed ischemic lesions and leptomeningeal enhancement, indicative of vasculitis.
- EEG showed focal abnormalities, and CSF analysis confirmed pleocytosis.
Findings:
- The patient was diagnosed with probable encephalitis associated with cerebral vasculitis post-COVID-19.
- Treatment with pulse steroids resulted in rapid clinical improvement.
- Follow-up demonstrated moderate neurological sequelae, including headaches and spatial deficits, with EEG abnormalities.
Implications:
- This case underscores the potential for severe neurological complications, including meningoencephalitis and vasculitis, following COVID-19 in children.
- Cerebral MRI and EEG are crucial diagnostic and monitoring tools for these conditions.
- Prompt recognition and management with immunomodulatory therapy, such as steroids, can lead to favorable outcomes.
Introduction:
Various neurologic manifestations have already been described in children during or after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. The central nervous system disorders reported in children are mainly encephalopathies during multisystem inflammatory syndrome. We present here an acute meningoencephalitis with cerebral vasculitis associated to a coronavirus disease 2019 (COVID-19) infection in a 13-year-old girl with a 1-year clinical, electroencephalogram (EEG), and magnetic resonance imaging (MRI) follow-up.
Case Report:
A 13-year-old girl presented acute symptoms of consciousness impairment, frontal headache, hyperthermia, and aphasia, with moderate lymphopenia (900/mm3), elevated C-reactive protein (17 mg/L), cerebrospinal fluid (CSF) pleocytosis (15 cells/mm3), slow background with frontal focalization on EEG, a left frontal ischemic lesion, leptomeningeal enhancement, and bilateral limbic fluid-attenuated inversion recovery hyperintensity on cerebral MRI. Reverse transcription-polymerase chain reaction for SARS-CoV-2 was positive in nasopharyngeal swab and COVID serology was positive for immunoglobulin (Ig) M and G, whereas extensive autoimmune antibody investigation was negative except for a positive low titer of anti-myelin oligodendrocyte glycoprotein in CSF and blood. The diagnosis of probable encephalitis associated to cerebral vasculitis after COVID infection was suggested and steroids pulse were started. She recovered within a few days. Six months later, she had moderate clinical sequels including persistent intermittent headaches, an isolated spatial deficit, and focal spikes on the EEG without argument for epilepsia.
Conclusion:
A teenager without previous medical history presented with acute encephalitis with leptomeningitis and vasculitis after a recent COVID-19 infection. Steroids pulse therapy allowed clinical improvement. Cerebral MRI and EEG helped diagnosis, follow-up of the encephalitis, and evolution after treatment.
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